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Me and ACA
I tried a bunch of times to get on NYS's health exchange last week. Dead end. The site went down for 'repairs' over the weekend, but as of 8 AM today it was up and running. Some thoughts.
The first step is to get a user ID. For those familiar with this type of registration process the Captchas etc. are not a big hurdle. But two 8 digit codes (no spaces please) are required on step one. My guess is that there are fair number of people who will struggle with this. The same could be said for the password requirements (eight digits, two numbers and one capital letter).
The NYS exchange wants more than the standard ID info of address and SS#. I was asked a series of questions to 'prove' my identity. I was asked to identify a financial institution that I had opened an account with in the past two years. Five banks were listed, and one of them was the bank I had in fact opened a new account.
Another question blew my mind. I have never purchased pet insurance, so this was a trick question that required the response "None of the above" to continue with registration.
These questions prove that the exchanges have access to a great deal of information about who is signing up. I suspect that the need for the servers to go out and gather the individual's data so that these questions can be posed, is the reason that the exchanges went down the first week. The plumbing for this can easily get clogged; the data bases for this type of info are huge. NYS has access to my IRS data, the pricing I got reflected the fact that my income was above the subsidy levels in the prior year.
Once you exist, the rest is straight forward. I'm single, 63; I'm a headache for ACA. Obamacare needs young healthy people to enroll. For every one of 'me' ACA will need a half-dozen twenty-year olds to balance the costs. I looked at the cheapest plan (Bronze - $360/mo) and the richest (Platinum - $620/mo). The difference between the two extremes is the annual deductible:
This pricing structure is flawed. For the Bronze plan I would pay $3,684 per year and face a$5,800 deductible. If I get sick, my all-in cost goes to $10,120. If I pay the high monthly premium I would pay $7,740 a year, but incur no deductibles. Therefore, in the event I need the insurance I would 'save' $2,380 by opting for the Platinum plan. At my age the Bronze plan is a bad bet.
I can easily envisage an age cohort of mine who opts for the Bronze plan, gets sick and then is stuck with a $5,800 bill that can't be paid. These very high deductibles are going to be a disaster for Obamacare. Who is going to eat the losses that will surely come from those with cheap plans and mega deductibles? The taxpayer will foot this bill....
I have medical insurance today that has similar features to the Platinum plan. It costs me $1,100 per month for the insurance. So I'm looking at a real savings of $5,760 per year! This is great news for me, and some will point to this and say that Obamacare is doing what it's supposed to do. The fact that I am now in a group that includes lots of younger people who will not need the insurance has brought down my costs.
This is going to fail. I should not be getting a subsidy from Obamacare. My investment income the past few years (thanks to ZIRP/QE) puts me in the top 2% (Income greater than $175k = top 2%). Why in hell should I be getting a subsidy? And if I'm getting a subsidy, who is going to pay it? Those twenty-somethings are going to save me $5,800 a year?? Why?
In spite of the large savings that I would realize from from signing up for Obamacare (a free one-month trip to Europe!) I did not hit the button. There is a catch in this for me. Can I keep the doctor that I have been seeing (and trust) for the past 25 years? There is no way to determine that. There is a field that allows you to check if your traditional doctor is covered by the plan. But when you ask, you get this:
Okay, this bug will get fixed someday, and when it does I will sign up for Obamacare (provided my Doc is in the group). When I do, I will save a bundle, but there is no way that this should be happening. Why is Obamacare putting big bucks in the pockets of geezers who are top 2%?
My conclusion is that the exchanges are setting the initial cost for insurance at rates that are artificially low. These are teaser rates that are designed to get folks to sign up. A year or two from now the insurance companies will be getting big increases. Whatever you think of Obamacare today, wait two years, you will come to hate it.
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Skateboarder Oh yes, there IS getting well. When my (former) doc said I would have a stroke and/or heart attack if I didn't accept the prescriptions that she insisted I take, I fired her and went cold turkey on low-carb, lost 25% of my body weight, my trigs went to rock bottom, inflammation went into remission, and I feel like I would like to have felt at 20. Did it myself, found a holistic M.D. who is a big help when I need him, doesn't bullshit me, and doesn't cost an arm and a leg. Medicare is losing NOTHING on me.
Can't have that now can we? Eat healthy and less instead of huge amounts of toxic corporate phood? Exercise instead of popping pills?
Those poor corporations! Won't you think of their bottom lines??
Quick, send in the lobbyists in DC, set up some campaign donations and hire some hookers with a hidden camera.
Coming soon: bans on buying or growing your own fresh foods due to the health hazard of not being sterile, mandatory statins added to drinking water, footpath toll booths to pay for service to runners, 5mph restriction for cyclists (to keep the children safe...think of the children).
Now get back on the couch client...I mean, citizen.
riphowardkatz
From Geezerville: zero percent Dude. What did you think?
Imagery
Thanks for the warning. Crossing TX off my list of possible retreats for shtf.
Johnny Moscow
NOT two parties here, only one. Demopublicans or Republicrats, all the same thing, crooks and liars.
deerhunter
I doubt soylent green, but do think a lot about Hospice.
P.S. did not dis you
Mediocritas
Insurance = gambling. Insurer gambles you won't get sick, have a fire or flood in your home, have a car accident. You gamble that you will. We buy insurance because we don't want to pay the cost of those problems, and gambling seems better than not gambling.
I already don't trust criminal congress or presidents or judges with my medical welfare, they make enough life-and-death bad decisions as it is.
P.S. Where do you live?
Insurance isn't gambling. Insurance works on probability and risk. It's based on discrimination, that's the nature of the industry. The insurance company charges premiums based on probability, and magnitude of risk. Smokers are charged more than non-smokers in health insurance, because smokers have a larger probability of developing lung problems. Premiums are there to cover the claims while minimizing the cost to the insurer. This is why women in their 20s are charged less than men in the same age for car insurance. Men are statistically more likely to get into a car accident, whether drunk driving, or whatever. Same goes for teen drivers, relatively inexperienced drivers such as teens are charged higher premiums, because they can as much as 4 times be likely to be in a car accident.
What government does with insurance, particularly health insurance isn't really insurance, but a form of socialism, where young, and healthy pay for the sick, and very old. Healthy people with no illness pay the same exact premium as someone who has a pre-existing condition. Since government banned pre-existing condition risk pooling, insurance companies sought to minimize the cost to their insurees by not accepting people with pre-existing conditions. Same thing goes for mental health issues, or you had history of mental illness, or visited a shrink for whatever emotional/mental problem you have. Insurance companies opt to insure costs are low to the current policy holders than accept people with existing conditions, or even history with depression, or mental issues, because government mandates in various states before Obamacare that psychaitrist, and shrinks should be payed for by insurance companies.
Insurance isn't socialism. It categorizes risk pools, and people with the risk pay the premiums with other people with similar risks. It makes no sense to charge a man maternal care when he is incapable of getting pregnant, as in the case of Obamacare. You just increase the cost for the man, so the woman can have maternal care, and doesn't have to pay. Socialized insurance means the losers are the ones who are price gouged, and winners are the people who extract claims in a context of insurance. If a teenage driver paid low premium, then adults would have to have their premiums raised relatively if the law demands you can't discriminate against kid drivers.
Do you now know what insurance is now? Insurance is a hedge against a future event that operates on probability, risk, and the magnitude of risk. It's not there for you consume goods, or services readily as if it's a ATM machine that spits out money all the time.
btw, while low earning people get more out of Soc Sec than higher earning people, and long lived (usually better off financially people) getting out more than they paid in, its not like old people retiring in next 10 years are ripping off young people as a whole....that was case in younger years of Soc Sec but now, the younger retiring soon boomers in general as a pool, are getting out pretty much what they paid in. Of course we can argue endlessly about what return on investement they are getting or lost by being taxed etc, but with current system, its far from older people retiring now getting out way more than they paid in, as a group....
"Insurance is a hedge against a future event that operates on probability, risk, and the magnitude of risk." So technically not life or house or car insurance, but instead, insurance against outliving savings, health care costs in old age, run by govt and it is also insurance against investment risk...that is, you can't blow it like your 401k, you can't mis invest and lose it, you can't get swindle out of it etc. Just a annuity that pays you your whole life is an insurance, so is Soc Sec, Medicare.
Also, Soc Sec and Medicare have trust funds so they are not simply young paying to old. It is not that different than a person saving money and then buying an annuity that pays out as long as they are alive but which leaves nothing if they dont live long. So Soc Sec and Medicare, somewhat like a pension, somewhat like insurance because they both involve taxing someone while they are working to pay for their old age expenses and also involve pooling risks (people who die young get nothing, people who live long and get expensive illnesses in old age get much, just some get little or much from car, house insurance).
In early 80s when Soc Sec was reformed, younger baby boomers were FICA taxed far in excess of what was needed to pay for elderly of their times. That extra revenue beyond what was being paid out was put into trust fund because everyone obviouisly saw they that baby boomers would be sudden huge draw down on Soc Sec that boomers kids would not be able to fully pay for Soc Sec. That trust fund is solvent to about 2037. To say that Soc Sec is just young people paying welfare to old people is not exactly fair, because some people who pay no Soc Sec tax, like say hedgies that make all their money from dividends, don't get into system but for rest, it is an all in pension system.
Unlike Defense, general federal govt spending, which have all been paid for last 50 years via deficit spending, i.e. we spent more on these programs than in taxes revenue we took in to pay for them, instead with Soc Sec and Medicare, the not only did not deficit spend to pay for it, we actually taxed more than it cost to do program at the time of taxing. What other part of govt has ever been taxed ahead of time to pay for future costs? Not our defense, not our FBI, not most state and local unfunded pensions...but Medicare and Soc Sec have been...so I do think of it as a pool, public insurance, more than welfare.
It is quite fair to characterize SS as welfare from young to old- that is precisely what it is.
When someone turns 65 and starts collecting where do you think that money comes from? Is the SS Trust fund stacks of $20's crammed into a warehouse someplace that was collected when current retirees were young? No, that money was spent decades ago and now their checks are is taken directly from the same revenue stream that everything else is- tax receipts and debt sale.
@dizzy
The USA seems to have gotten itself into a death spiral based largely on this gambling (but not the only factor).
Insurance companies wedge themselves between potential patients and healthcare providers. They start making buckets of money.
Providers see the cash being made and want a cut so they raise prices (just ask for fully itemised billing to see the ripoff). Providers don't feel bad about overcharging because they say, "you've got insurance right? Don't worry, insurance will pay". Rising costs scare more people into taking insurance.
Rising costs eat into insurance company profits, so they increase the scare tactic advertising, raise premiums, hire lawyers to avoid payouts, and hire lobbyists to mandate captive clients. The spiral continues.
Lawyers see the buckets of money being made all around and want their cut, finding plenty of squeezed patients desperate to find a way to recover money. Legal battles between patients and providers, or between patients and insurers, they don't care. Medical costs rise higher to factor in additional litigation insurance, feeding back into higher health insurance premiums. The spiral continues.
The arms race for profits enriches insurers, lawyers and healthcare providers so they all end up working together, to lobby DC and keep the situation exactly as it is (even though they all complain about each other). Everyone else loses.
Costs end up spiralling so high that everyone is FORCED to buy insurance and cross their fingers that it actually pays out. One day we'll end up in the ridiculous situation where a policy costs more than healthcare before the spiral started.
The fix requires a multi-pronged attack, but I'd be going after insurers #1, lawyers #2 as the highest leverage targets for bringing down costs. They're nothing but parasites that add layers of expense.
"Insurance = gambling": I beg to differ, this is the British/American tradition
the european continental tradition started with cow farmers who just shared their losses. at the origin it started like this: 50 farmers have 1'000 cows. they know that most probably 20 will die. they all chip in for this loss, regardless if it's spread out or incurred by the same farmer
gambling is still viewed as a sin, in many parts of this world, and kept separate from investing, in the minds of most
Interesting point.
I have always viewed insurance as gambling, making a bet regarding a future negative event, a bet that absolutely must involve an "insurable interest" for the gambler in order to reduce moral hazard (many argue that a lack of insurable interest, associated with CDSs, was a major contributor to the financial crisis).
But you're quite right, insurance doesn't have to be gambler versus house. What you described is an insurance equivalent of a credit union. If the negative event did not occur (cows did not die) then house "profits" would be returned to the members. This eliminates my core objections to insurance as it stands (where profits are maximized by scamming people, ie, maximizing the spread between perceived risk (client) and actual risk (kept secret by actuaries)).
Pre-payment into a kitty still represents an inefficiency but it's certainly better than the gambling version of insurance. It's different from a government-run deferred scheme in that it's much more local and money is returned directly. I'd guess that deferring would be superior, but perhaps the "distance effects" in overly centralized schemes would be wasteful enough to make a localized insurance union worthwhile. I also wonder if there might not be a "tragedy of the commons risk", for example a farmer deliberately killing an old cow to get the money for a replacement. Either way it's still better than gambler vs house.
Pardon my ignorance, but do such companies exist? (Insurance unions, somewhat analogous to a credit union in which "profits" are returned only to the policy takers (not every member in the union), minus administrative expenses).
insurance is mostly (or predominantly) in what Taleb calls "Mediocristan", i.e. the world of meaningful statistics around "normal" distributions. imo the math there is clear: if your size vs the negative event allows it, the cheapest and most efficient option is (A) self-insurance, i.e no insurance. the downside of it is that if you are poor and uninsured, you might get bitten by the dogs of Fate
the most expensive and inefficient option is (D) then to have many (possibly predatory) intermediaries to finance it and out to profit from it, perhaps with an inefficient (and possibly very corrupt) gov thrown in for good measure
imho ObamaCare seems to follow the Swiss model (based on the obligation to be insured offset by freedom of choice of insurer and gov monitoring and restrictions on health insurers), though forgetting that the US hasn't the less predatory corps and hasn't the more efficient gov to watch them
the next in line is (C) the National Health Service model, heavely dependent on the efficiency of gov. Interestingly, the Soviet model had some surprising efficiencies in preventative medicine (otherwise it was one of the shittiest ever) because they could order you to engage in massive return-on-scale programs
and between A and C in my own ranking you'll find (B) this commonly called mutual insurance model, mostly based on cooperatives - which in Europe generally don't extend to health because most countries have a (C) "NHS" with their size return-on-scale advantages vs their gov inefficiency disadvantages
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See this article of the "Co-operative News"
http://www.thenews.coop/article/european-parliament-adopts-report-statut...
"According to statistics published in the European Parliament Library, mutuals are reported to employ 350,000 people in Europe, they represent more than €180 billion in insurance premiums and provide services to 160 million citizens and have a natural role to play in the support of existing welfare systems and the social economy. Whilst almost 70% of the total number of insurance companies in Europe are mutual societies…" (note they are many, but usually not big. beware of statistics. yet yes, it's very common)
I think one of the biggest is this one, interestingly in the UK http://en.wikipedia.org/wiki/Cooperative_Insurance
Here you see how the EU is defining them, all in the context of promoting a common market policies for the status of "European Cooperative Society (SCE)". remember, size matters
http://europa.eu/legislation_summaries/employment_and_social_policy/soci...
the EU definition is "Cooperative society: autonomous associations made up of persons coming together voluntarily to meet their common economic, social and cultural aspirations and needs, through the means of a company owned collectively and where the power is democratically exercised."
note that English is not a very kind language to Cooperatives, on the web, particularly on wikipedia. See here
http://en.wikipedia.org/wiki/Cooperative#Credit_unions.2C_cooperative_ba...
there isn't even an article about Co-operative insurance. But if you switch to other languages, it's full of history, the thought behind them etc. etc.
example: in Italian you'll find http://it.wikipedia.org/wiki/Mutua_assicuratrice
and in German you'll find http://de.wikipedia.org/wiki/Versicherung_(Kollektiv)
but if you follow the links in English… you are redirected to the "standard financial insurance models", which are based on the usual "Lloyds" betting in the pub "Oceanic"tradition
Sincere thanks for this post Ghordius!
I use a credit union but it had never occurred to me to do the same for insurance as I had not actually encountered such companies operating here.
Now that I know better what to look for (eg, http://en.wikipedia.org/wiki/Mutual_insurance ), I've just done a quick trawl and it seems that the history here is, yet again, strongly tied to (a casualty of) the English-speaking new order that started in the 80's with Reagan & Thatcher and is busy blowing itself up right now.
Turns out that, prior to 1980, mutuals were actually the dominant form of insurance here but they now all appear to have gone the way of the dodo, demutualising and converting to a shareholder model. Any wonder I hadn't heard of them. What a shame. I wonder if they were pushed by govt policy or just lured by the equity $$$s?
The difference between the English-speaking bankster empire and the rest on this matter is quite fascinating. Seems you are right, information in the Empire is fairly sparse.
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The model where I live is a C model that actually works very well (strong oversight and a populace that is politically engaged (although that's fading)). Unfortunately, it is degrading into a C-D hybrid as banksters gain more traction in the Capitol via free trade agreement policy laundering and people gradually disconnecting from politics.
My issue with Obamacare is, as you alluded to, that the US administration is already far too controlled by corporate interests for good to come of it. Rather than ending up like the Swiss model, it's more likely to be horribly overcomplicated and be yet another mandated transfer of wealth from Main St to Wall St in keeping with things like this ($50B / yr gift to pharma) http://en.wikipedia.org/wiki/Medicare_Part_D#Criticisms
thank you for finding that article. my biggest problem on the web - besides age - is that I'm simply still inept in googling. Even Tyler has chided me a few times. I'm thankful that my little basic knowledge accumulated before the age of the Internet
I'd say it's mostly "lured by the equity $$$" all in all an effect of
financialization (worthwhile looking into it), i.e. as Gerald Epstein defined it
"Financialization refers to the increasing importance of financial markets, financial motives, financial institutions, and financial elites in the operation of the economy and its governing institutions, both at the national and international levels"
or, more snarkily, as Michael Hudson describes it ""a lapse back into the pre-industrial usury and rent economy of European feudalism""
so it's no wonder that in English the key wiki article is... demutualization
"financials" can sometimes be utterly blind to any form of economy that does not "produce" stocks or bonds, and so starting points to further financial products. and easy money favours "financials". add in that lobbying is easier if you have big and profitable financial flows to protect...
I heartily agree with Hudson. We are regressing into nations of rent-seekers ( http://en.wikipedia.org/wiki/Rent-seeking ) to the long term detriment of society.
A simple anecdotal example from my recent past. I invented a way to do "spatial DNA sequencing" at cellular resolution, a powerful tool for pathology laboratories about 1000 times cheaper than current technology (for the equivalent data), but thanks to recent govt science funding cuts (caused by the rabid anti-govt types), I had to seek private sector funding for development (despite propaganda to the contrary, the private sector is far more risk averse when it comes to such things, but forget about getting the rabid anti-gov crowd around here to ever accept this fact). Investor after investor said it was fantastic but would not fund because it wasn't worth the risk given they could just speculate on various asset classes for easy money (mainly property here).
So the project is dead. Actual advancement, the type that produces organic economic growth that in turn produces healthy leverage, being squandered so that people can get stuck in a reflexivity trap / Ponzi scheme, flipping assets to each other, running on the spot faster and faster like the Red Queen. Sad.
Financialisation / privatisation / deregulation to excess is sending us backwards in every way. What the GDP chasers seem to not understand is that human civilization is subject to entropy. As populations grow, resource demands become more onerous and the environment is degraded, technology MUST advance to support living standards. Flipping assets around might make GDP per capita look great but it's a hollow number given the erosion of "organic" economic activity that's being caused by financialisation (physics PhDs working for investment banks etc). When reality bites it's going to bite hard and we'll look back on the epic misallocation of human thinking, attention, energy and capital that is financialisation and wonder how we could have been so stupid,
Winston Smith 2009
Good comment.
Pressure building up among those who will pay?
Inevitable equal and opposite reaction about to happen? Or eventually?
williambanzai7
Regarding Hong Kong, Singapore, and Bangkok:
Interesting! But why is this possible? Too good to be true.
Low-paid docs and tech?
Subsidized by banks?
Subsidized by taxpayers who don't mind?
Something seems unusual about the picture.
America is too far gone. Let the private sector have too much power in healthcare and they'll rip your face off because a negotiation where your own life is on the table is one where you have no bargaining power whatsoever. You'll pay whatever they ask, and without some form of protection for you from a big brother, they'll take everything you have. Insurance just exacerbates the problem.
The Romans figured out 2000 years ago why fire services should never be privatised. It's the same for police, military and any profession where service means defending lives or valuable property. Quality essential healthcare must ALWAYS be quickly available as a not-for-profit option. (Conversely, non-essential or unproven procedures, like cosmetic surgery or acupuncture have no place being publicly funded, and should be private).
Depending on insurance is insane, guaranteed to be more expensive than an expanded public system. You are being asked to pay in advance for service that you may or may not need. How is that efficient? And you're clearly overpaying because insurance companies are clearly profitable. Every dollar of their profit is a dollar of overpayment for healthcare not delivered. Can it.
In my country the public hospitals are routinely better than the private ones. You walk in, get what you need, walk out and don't worry about cost, which is a major relief. The govt tallies up costs and splits it to taxpayers (the levy is means tested, reduced by having private insurance and reduced if no public care is actually used). Zero extra costs to pad insurance company profits, the system is pay as you go and obviously more efficient because it comes out much cheaper, net, right across the OECD outside of the USA.
Smashing private healthcare corporations and increasing public healthcare spending to make care more available, not subsidising private insurance (Obamacare is insane), kicking lobbyists out of DC, punishing price gouging, reducing litigation. These are the answers, making US healthcare more like the rest of the OECD, cheaper and better. Yet antisocialists keep spinning their crap about how government is so inefficient, cutting off their own noses to spite their faces. They whinge about the current system on the one hand, then defend it with the other!
I don't bother with private cover. We have a great public hospital literally 200 metres away and use it when needed. I happily pay the public care surcharges with my income tax and costs are less than half of equivalent private cover. Surprise, surprise, net healthcare costs per capita here are half those of the USA and health outcomes are also better.
20 years ago, it was even better (a quarter the cost of the USA) but then our idiot government signed a free trade agreement with the USA that significantly weakened the public sector and opened the door to financial parasites and drug companies to move in and start fucking everything up. Advertising for private care and private insurance is everywhere now, again something extra that you pay for when using the private system. Only suckers fall for it.
Sincere condolences if you live in the USA. Wall St, Big Pharma and their lobbyists in DC are totally in charge of healthcare now, raping you for every last dollar the moment you sneeze. There is no chance of a change for the better given that the USA can't even manage something so simple as changing to the metric system.
You're throwing the baby out with the bathwater here.
As you can see in my post above, I agree that urgent care gives no room for negotiating, and maybe that part should be running under a public scheme - but NOT for free no matter how often you visit.
However the majority of healthcare costs occur in non-urgent scenarios. Why do you think the highly sophisticated now get their hip replacements or whatever done in Singapore, which comes cheaper including travel costs?
Just because the US calls its healthcare "privately" run (PINO = private in name only) and it's double the cost than many correctly named public ones, doesn't prove a thing.
True private would mean competition including openly shown prices and penalties for fraud.
Such a system would provide better healthcare at a cost lower than any acceptable public one.
Healthcare insurance profits are not exceptionally high compared to any other industry. You need food, and clothing more than healthcare, yet you don't see "evil capitalists" profitting out of price gouging. Your argument is automatically debunked there. People don't want to pay for healthcare, politicians know this. The problem with healthcare prices is regulations, and government. Programs like Medicare are not cheap. Government can't produce wealth like the private sector can. It can't make quality higher, and costs competitive at the same time. There is no competitive incentive in it at the individual level. That's why healthcare systems like Britain ration care, they have fewer doctors, fewer everything, and extend wait times. Timely access declines.
The problems in the US healthcare system is that there is over dependence on wanting somebody to foot the bill instead of paying for one's own healthcare cost. It's the middle man. No different than someone using someone else's credit card, and buying the most expensive things, going on a shopping spree. It's just logical sense. There is tax loopholes that give incentive to prefer insurance over direct income paying for healthcare. The fact you neglect the mention the underlying prices of US medical care, just the insurance companies shows you have no credibie knowledge on the subject. There was a time when America didn't have health care problems associated with rapidly rising costs. That's because there was less government back then then there is now. Programs like Medicare contribute to high prices, because seniors use it simiar to someone use another person's credit card to pay for things. They don't care about how much something costs, therefore sellers of medical care can rise the price to the ceiling. Very few seniors actually pay for their healthcare. Almost all of them have Federal Government paying the bill. The problem is easy to recognise.
excellent comment, Mediocritas
worth repeating: "The Romans figured out 2000 years ago why fire services should never be privatised. It's the same for police, military and any profession where service means defending lives or valuable property"
Former CIGNA medical insurance executive: Health insurance industry has become "a giant ATM for Wall Street"
http://www.youtube.com/watch?v=A03HyG3RGnQ
Excellent post and from my own knowledge, 100% factually correct with respect to the situation here in the US. You describe perfectly the core problem here in the US - OWNED GOVERNMENT due to our entirely money driven and ridiculously long election process combined with a citizenry unable or unwilling to see through the billions of dollars worth of special interest funded propaganda delivered by a corporate mainstream media acting as the lapdog of that owned government.
neighbor is a 57 year old chiropracter, she said ACA requires her to buy 10k worth of software to be in the new governement payment plan. Her choice, retire early. Guess that income tax source just went up in smoke five or six years earlier. We aren't sheep we seem to be dairy cows and if you work and pay Fed taxes that is exactly how they look at you. Trouble is a dairy cow eventually runs out of peak production. That is where McDonalds comes into the picture. Doctor quoted word for word a major insurance company benefits rep telling him while he was questioning payment for an 80 year old terminal patient, " we don't pay for dying". Welcome to the brave new world. Soylent Green anyone? Stay healthy my friends.
please 10 k in software that will likely be good for at least 10 years, not great deal...but at a cost of $1000 a year.... not exactly a huge toll on a provider who likely is getting a big share of their money from govt contracts... I know many small business that choose to close and retire because bank doesnt want to lend to them and they would rather cas out real estate and retire, I also know lots of small businesses that get squeezed on technology compared to big competitors dont have economy of scale to benefit from huge software systems that make for great efficiencies, its a choice people make but not end of world
Thanks Bruce, for writing such a straight-forward, level headed critique on this monster. My wife won't listen to me, but she just might listen to you : ). I've tried to explain to her that this program was fundamentally created entirely by, and for, the insurance industry itself; the buzzword, "healthcare" being just the bait for a long-running scam.
Bruce, I can't follow your reasoning here.
1. In bronze you'll pay 12x $360 = $4320, while in gold 12x $620 = $7440 or $3120 more to "avoid" the $5800 deductible.
However you miss the point that you get zero Out-of-Network coverage - this is less about keeping your doctor when you have time to choose, but more about when urgent care is needed and you're not sure if you can still make phone calls to find a near-by In-Network provider!
2. I have catastrophic insurance only for many years already, currently I pay $269 a month with $5900 deductible in-network and double that ($11800) out-of-network. Being on the left coast, I surmise things are no so much different here from NY.
I'm not wasting my time on government scam websites, but what I expect is premiums generally to rise because bronze effectively puts a floor to lowest premiums any insurer will offer, even grandfathered ones outside Obamacare.
Oh, and btw these questions you had to answer is just the normal stuff for opening a bank account or similar online, which they compile using your credit report history.
Non-sensical post deleted.
For the love of Pete...
Get to know a doctor and a nurse and pay cash!
Something really trouble? Medical tourism...
Doesn't AFLAC sell a hybrid life/health insurance product in Japan? ....
Dudes...it's not just the price...
BUT WHAT IS COVERED!!!!!
Big changes there....ergo, the price shift.
There's no free lunch.
FWIW: Tennessee did this (massive expansion of Medicare) in the late 90's and by 2004, Gov. Bredeson had to close it down---
collapsed under its own weight.
Congrats BK ... your excellent post has turned into TrollCentral
Skateboarder, I hear you. This is a really ugly piece of work, 5 x worse then Real I.D. was shaping up to be. I am highly pissed but a firm believer in focusing and utilizing anger. I can say one thing, within say 5 years maximum I will be completely off the grid and underground and I am not the only one thinking this way.
Four years ago I concluded the greater part of my day-to-day problems, the needless shit that made my life tougher, were (a) governmental and (b) electronic.
I am thinking about my government in ways that astound me at this point in life; I never thought I would be in this situation.
This article is a joke. Half of the article was allocated to login concerns and or 1st day errors. Plus his concerns about the different between deductible and monthly choices is how insurance companies work.
Perhaps having his drivers licenses confiscated for this chap should not be the only thing he is not allowed to do...
Thanks Bruce for opening the topic on Obamacare. It's hard to get factual info on it and even when I went to the web site to look for my Dad (who live sin Texas) I was not able to get to a page that actually compared plan options for him.
been impossible to get the info actually. one thought i did have vis a vis pet insurance is that this might be a way to get health insurance for yourself. with costs so high for health insurance period i have heard there are those who go to the vet...not saying its true just a rumor but might explain the question. i will go check the site out in a week or so. it's never a good sign when employers just start dumping the health coverage of their employees. i also find "opt outs" rather strange too. that strikes me as very good company plans with good company doctors...and one big problem here could be the lack of doctors combined with a sudden "40 million people with insurance." or more...
I am consistently amazed at the discussions of "at whose expense" of those like yourself, in the upper end of the income spectrum. You make alot of money because those underneath you in said spectrum make alot less than they are worth in the overall production of wealth. Fuck you on their behalf for pretending to be be concerned that they are being screwed on their last mortgage payment.
Bruce, you know why they are doing this to you, don't you?
You and those like you have ASSETS, and they want them.
If you don't have insurance you fear that you will get sick and lose your assets to pay for care.
Therefore, the fear will likely drive you to buy "insurance" that isn't really insurance for healthcare but rather a "I don't want to go bankrupt if I have to be in the hospital" plan.
Either way they will get your assets for providing nothing, or for fixing you up and making you go bankrupt paying for it.
You will either be bled out to the tune of a $620 per month premium that will go up 15% per year (and trust me, there are deductibles and fees even in that one) OR you will not pay the exorbitant premiums then be taken to the cleaners when you do need care.
They are going to bleed out your assets coming or going, by hook or by crook - and it has absolutely nothing to do with "affordable" or "healthcare". It is an asset confiscation scheme.
THAT IS THE PLAN.
That was a very astute observation. However, being in the medical field and listening to some horrendous stories, I think this is happening already. Seniors naturally have built up more capital than younger people but today they really have to be extraordinarily wealthy to keep these assets safe. I've seen 500k to 1Mil gobbled up by medical expenses. Assets not inherited by children but auctioned off to pay for exorbitant medical bills. Only way out of this scenario in my view is PMs or something untraceable ( certainly hard to do today). I think Obamacare will just speed up the process. Once all available assets are transferred then the real fun begins. Shit by any other name...
Miffed;-)
Yup. They are bleeding out two or three generations of savings, paid off mortgages, and responsible living.
This is war. It is a war against hard working responsible people who have done the right thing their entire life against the parasites of Wall Street and Washington.
This is not a political war. This is not an ideological war. It is a war of assets, a war of those who have worked for what they have against those who are parasites that feed on those who produce something useful.
Doctors, Nurses, and regular real people are the victims - and the parasites in Washington and Wall Street who are the aggressive parasites attacking the assets of real people.
Amen Eb, I am one of those who played by the rules and will get burned. At least Ive woke up before it completely blows. One must steel oneself to survive this unscrupulous attack on us. I consider it a war as well and prepping for the fact. When ones fruits of ones labors have been stolen by an immoral few how can it be anything but! At 52, there are only so many options and limited time to do them. I am saddened my children will face the brunt of this.
Miffed;-)
Did anyone else notice technology & healthcare companies got creamed today?
What could it all possibly mean?...lol.
Just read a piece by John Tooby..., claims that epidemiologists have determined it was 1905 before you were better off going to a doctor.
For what? My own opinion is that only for emergencies is the benefit likely to exceed the damage.
These are some of the questions that should be asked. Is modern medicine even a good idea in anything like its present form? I think not.
Bruce, what you might have missed in the platinum coverage are admission copays, typically $500 for a hospital admission and the like.
We should also all know by now that a deductible is what you'll need to spend in covered charges (not billed) before $1 of insurance coverage kicks in. What isn't often considered is the Out of Pocket Maximum or (OOP), this is the total dollar amount you're ultimately liable for, with some exceptions like non-covered charges. However, in sneaky ways, like in platinum plan copays, there may be no limit to your OOP if copays don't apply!
Another important consideration is "non-covered charges". Obamacare will madate coverage for "routine screenings", but you need to be careful of what this actually includes. If you doctor orders a blood test on what seems to be routine but is not considered routine, like a blood test for diabetes, it will be non-covered and you will be billed for the balance. Non-covered charges are particularly pernicious becuse it's all based on a complex procedure coding system that most insurance companies have computer automated to the point that no human interaction is required. However, physician offices are stacked with low skilled billing clerks that take classes on maximizing revenue and slipping in a non-covered charge here and there to them is like an extra bag to the airline industry -a pure profit center.
Also important is the type of plan you select. Your sceen pics don't indicate if the bronze plan will be administered by the dreaded Health Maintenace Organization (HMO) or a Preferred Provider Organization (PPO). Here in Texas many of the BCBS plans will be HMO admistered (remember them? They're baaaack). Under the HMO, your primary care physician receives a lump sum payment for each patient enrolled and must work within that amount for all care. Depending on the contract, this may include payment for all lab and x-rays! The gambit from the physician's viewpoint is to sign-up as many as possible and treat as few as possible or treat as minimally as possible. Most physician's are upstanding and do not abuse the system. Their billing office may be very different. If you saw the recent 60 Minutes exposee on Assisted Living Centers, you'll know what I mean.
Platinum plans for someone your age is the only way to go, God forbid you should have a heart attack, but if you do, the ambulance company will likely check with the insurance company under "pre-authorization requirements" as to which hospital to direct you to. It's very complicated becuase of contract between the insurance company and each hospital, but if you have a "limited plan" (or maybe evven the platinum) you may actually be directed past a closer and better hospital for your condition in favor of the cost savings at another (especially if you live in a high density location with multiple choices). Also, becuase of budget considrations, procedures considered "elective" (non-life threatening) may be postponed from one financial quarter to the next so the market expections of earning are met!!!
Lastly, let me just add a word about the relationship between the insurance company and the hospital. Ever noticed that the names of hospitals and insurance companies are eerily similiar? This is no simple coincidence. Humana Insuance Company and Humana Hospitals are subsidiaries of Humana the parent. Humana Insurance must spnd no less than 85% of all premiums on medical claims, medical claims often submitted by Humana Hospitals....see where I'm going with this? There are collateral contractual agreements between all parties, except the patient, and if you want the real skinny on this, investigate the provider contract department of any insurance company, or ask to compare & contrast some actual contracts.
Bruce:
why do you say you are getting a subsidy...its not like you qualify for the actual subsidies being provided by ACA for low wage people , and older people can and do get charged more than younger people per ACA, the amount of the difference is simply capped to certain differential in exchanges...., so I'm assuming you think younger peoples rates are going up to make yours lower, which may or may not be the case...you've hardly proved that. I know younger people in MN that are getting better deal on my state's MN, MNsure site, and its not because they are getting subsidizzed by older people.
Its funny you are now complaining you should benefit from being in pool with younger people, and yet our tax system, at least unless you are the 0.1 or the 0.1 is progessive, so high earners are already contributing more taxes, and to extent many older people are higher earning than younger people, voila, don't feel so bad for young people.
If you consider your rate on the exchange a subsidy, than the current, long accepted federal law that requires big employees to not discirminate against sick people joing their employers health insurance pool are getting "subsidies" also, I have no one freak out about this in last decades...the younger healther employees are subsidizing the older sicker employees as the youngs insurance really costs less but all the employees get more or less same benefits.
To that end, all universal health care systems in UK, Canada, Germany, Australia, Japan, Switzerland etc involve young people subsidizing older people but in these countries they also have progressive tax systems generally, so rich people, young or old, do pay their due, even if their health car tax "premium" is lessened compared to their need.
If it really chaps your hide, we could means test your ACA exchnage premiums ala Medicare, and use that money to young peoples health insurance even cheaper....a slight revision.
There are tons of wonks and economists that have really done the numbers on and your anecodote proves nothing about the viability.
'Wonks' and 'economists' have done the numbers and that proves the viability??
Pleeeze......
seriously Bruce, that is a pretty knee jerk, emotional response, in no way addressing my angle that your cost savings may not be completely or even partially due to young people getting screwed.
Your dismissing tons of analysis, research done by all sorts on this by your one case, anecdote was a bit much, but you made your case from your angle.
But just dismissing tons of research, on many sides of issues, with a "pleeeze" is troll-like response. So I guess looking at many angles, looking at data, numbers etc is just a bunch of crazy liberal hooey, you, and you alone have grasp on truth from your one case?
And how does Switzerland provide universal care and subsidize old people with a partically private plan sort of like ACA....if ACA is doomed to failure, why is Swiss or Germanies or UKs system doomed too. If ACA is doomed, could it be reformed to be better like Swiss system?
I typically like your smart, looking-at-numbers on things though I often disagree.... but in this case, you just look at your case, and your argument is done. Why not all the numbers, like how many young people need to enroll to make this work, will it get to those numbers etc. Instead, you dismiss with "pleeze".
Was what I said besides suggesting looking a research worthy of just being slapped away dismissively?
I get better interaction at partisan sites from people far less smart than you. I don't get this, coming from you.
Got links to some hard data provided by these wonks and economists (something that actually shows their data and methodology and not jsut pronouncements in some pathetic article)?